Apoyo y Polladas: A Social Network Analysis of the Correlates of Food Insecurity Vulnerability and Health in an Urban Informal Settlement in Lima, Peru

Objectives: The primary aim of this dissertation was to examine the impact of social relationships on vulnerability to food insecurity and depression among women living in an urban informal settlement in Lima, Peru. Using theory and methods from biocultural anthropology, it sought to explore how women describe the types of challenges they face, termed "shocks," and what resources they mobilize to overcome these challenges. Methods: A sequential mixed methods research design was employed. Women and their children were recruited from two communities for participation in focus groups, individual interviews, surveys, anthropometric measurements, and blood samples. A modified grounded theory approach was used for qualitative coding, logistic regression models were employed with the survey data, and laboratory methods were used to evaluate biomarkers. Results: Thirty-two women participated in focus groups and 15 women engaged in interviews. One hundred and thirty-five women completed surveys and 44 women and 84 children participated in anthropometric and biomarker data collection. Women experienced a high number of shocks and had relatively small and homogenous social networks. Eighty-eight percent of the sample experienced some level of food insecurity, and 57 percent of women had symptoms of depression. Measures of social support and social capital did not ameliorate the effect of shocks on food insecurity and depression and shocks were associated with the likelihood of both outcomes. Women reported making strategic choices to cope with insecurity and buffer their children from hunger. These actions are not cost neutral and likely contribute to the burden of psychosocial and embodied stress in women. Along with the intergenerational transmission of these risk factors, the low intake of fruits and vegetables and high consumption of starches and fats likely adds to the high rates of overweight and obesity found in both women (75 percent) and their children (30 percent). Conclusions: Efforts should be made to address economic independence and mental health care for women. In addition, opportunities to strengthen social capital through activities that encourage women to seek positions of power may serve to address the multifactorial issues identified by this research. Researchers and public health practitioners should consider including a measurement of shocks to provide insight into the factors that create disparities in food insecurity and depression among economically marginalized populations. In addition, they must adjust their expectations of how food insecurity presents in urban informal settlements to acknowledge the coexistence of hunger and overweight and obesity. This should include seeking a greater understanding of diet and activity patterns and shifting interventions from those focused solely on individual-level behaviors to the broader determinants of health.